Extra Help
Extra Help is a Medicare Part D premium and cost-sharing subsidy program of the Social Security Administration. The program is for people with limited income and assets. People enrolled in Medicare who are also enrolled in federally funded MA or an MSP, or who receive SSI, are eligible for Extra Help.
- Extra Help pays the Part D premium amount up to the benchmark amount. Extra Help will pay the benchmark amount and the client is responsible for the additional portion of the premium.
The amount to allow as a Medicare premium deduction is provided for you on the current year “Amounts in Excess of Medicare Part D Benchmark to Apply as a Medical Expense” chart. You can access this chart through ONEsource in the Resources section.
- The Medicare Part D plan is responsible for providing refunds of the monthly premiums and other cost-sharing expenses such as deductibles, coinsurance and co-payments to enrollees who qualify for Extra Help. Reimbursement should occur back to the first month in which the enrollee is full-benefit dual-eligible (MA and Medicare Part D). Under Extra Help, the most an enrollee must pay for drug costs is determined annually for generic and brand-name drugs. Notify the client to request reimbursement of Medicare Part D cost-sharing amounts that were incurred prior to Extra Help. Use verified Part D costs for which the client is responsible as a deduction on the LTC income calculation.
To Do:Take a minute to find the list of Medicare Part D Benchmark Plans in the ONEsource Resources section and the current year “Amounts in Excess of Medicare Part D Benchmark to Apply as a Medical Expense” chart.
Do you want to learn more about Medicare benefits? Visit medicare.gov and explore the information found on this helpful website!